College Statement Regarding Intravitreal Injections Administered by Non-Medical Practitioners in the Hospital Authority

Dear Sir/Madam,

In the light of the recent trial by the Hospital Authority to allow persons other than qualified physicians to perform the operations of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs on patients, the College of Ophthalmologists of Hong Kong expresses its serious concerns and issues the following statement:

Intravitreal injection is an invasive operation that carries risk of potentially serious complications, including but not limited to bacterial infections or endophthalmitis, intraocular hemorrhage, traumatic cataract, retinal detachment, and even blindness.

Only a few places in the world, such as Singapore and the United Kingdom, allow persons other than qualified physicians to perform this operation in their clinics and hospitals. Although these places profess that this operation would be performed under supervision and was the only way to cope with high volumes, this is clearly a sub-optimal solution. That is why, most developed countries in Europe, North America, Australasia, and Asia require intravitreal injections of anti-VEGF drugs to be performed by specialist doctors trained in these operations, or by qualified physicians undergoing specialist ophthalmological training and even then, under supervision. Furthermore, the drug’s package insert clearly states that this medication is to be administered only by a qualified physician. Therefore, the College of Ophthalmologists of Hong Kong has serious reservations about this trial arrangement.

We understand that the Hospital Authority has a large number of patients requiring intravitreal injections of anti-VEGF drugs, resulting in long waiting times for the operations. However, there are many other effective and safe ways to shorten the waiting time, such as public-private partnerships, collaborations with non-governmental organizations, and Hospital Authority’s own Special Honorarium Scheme (SHS). We believe that intravitreal injections of anti-VEGF drugs by qualified physicians is the safest option. Hong Kong has sufficient numbers of qualified physicians and does not need to adopt the sub-optimal solution now undertaken by the Hospital Authority.
香港眼科醫學院理解醫院管理局病人眾多,輪候進行眼內玻璃體腔內抗血管內皮生長因子注射手術時間長。但其實縮短輪候時間有很多其他有效及安全的方法,包括公私營醫療合作 (Public Private Partnership)、與非政府機構 (Non-Government Organization) 合作、及特別酬金計劃 (Special Honorarium Scheme) 等。而情況允許下,由醫生替病人進行眼內玻璃體腔內抗血管內皮生長因子注射手術為最安全選擇。

The College of Ophthalmologists of Hong Kong will continue to work with the Hospital Authority to explore viable and safe options to shorten the waiting time, while striking an appropriate balance between timely treatment and patient safety, always bearing in mind that the interest of the patient is of paramount importance.

The College of Ophthalmologists of Hong Kong